Healthcare Provider Details

I. General information

NPI: 1588028286
Provider Name (Legal Business Name): YUAN ZHENG GAO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2016
Last Update Date: 07/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE STREET SUITE MS-117 PATHOLOGY PROGRAM
LEXINGTON KY
40536
US

IV. Provider business mailing address

UNIVERSITY OF KENTUCKY 800 ROSE STREET
LEXINGTON KY
40536-0293
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-6183
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License NumberIP1519
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: